Dr. J. Lane Tanner; Developmental-Behavioral Pediatrician, and Associate Director, Division of Mental Health and Child Development, UCSF Benioff Children’s Hospital Oakland

Q: When a child has trouble sitting still, paying attention or regulating his or her body at school, how does a parent know if this is age-appropriate behavior or a sign of a developmental problem?

A:  A common example of this a preschooler who is having terrible tantrums and behavior is that quite disruptive at school or at home.  But upon evaluation, we come to find at the root of the problem is a speech and language delay. This might be a child who’s really not able to get his wants and needs across and so the behavior may be rooted in frustration.

There are certainly children that we see where the match between the child’s temperament and the preschool, is not ideal.  For example, a child might be quite active or intense, or social and gregarious, and really wants to mix it up with other kids.  That child can be doing very poorly in one preschool and then change preschools and the child is fine.  Parents always do their best to feel this out beforehand, but a pediatrician can also help with this determination.

Q: Who should parents consult?

A:  When there is a question about a child’s behavior, parents are pretty attuned to their kids and I take their questions and concerns seriously.  The person who is best able to help them with their next step is the child’s pediatrician. They should have consultation with their primary pediatrician who should be trained to detect and screen for developmental differences and delays, or significant behavioral or psychological problems.

Q: If there is some type of problem or disability that needs to be addressed, who are some of the doctors that might be able to help after first consulting with a pediatrician?

A:  Who is best for a referral is an important question.  Depending on the issues of concern, a developmental or behavioral pediatrician might be the next person to consult.  A psychologist may be appropriate, if the concern is around learning disabilities – especially if what’s really needed is careful testing of a child’s strengths and weaknesses with respect to learning.  Or speech and language pathologist, if there is a straightforward problem with speech.  A child psychiatrist might be consulted if the concerns are mainly around mental health or behavior.

Q: What if parents are concerned about more than one issue?

A:  Clarifying what is going on is the first step since there might be overlapping areas of concern.   How much is a behavioral problem really rooted in some kind of a developmental disability, like a learning disability or an attention problem?   After consulting with a pediatrician, an evaluation with a pediatric specialist is the next step, rather than jumping into therapy.